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Short Report

Factors Associated with Lumbar Puncture Performance in Zambia

Deanna Saylor Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
Department of Internal Medicine, University Teaching Hospitals–Adult Hospital, Lusaka, Zambia;

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Melissa Elafros Department of Neurology, University of Michigan, Ann Arbor, Michigan;

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David Bearden Department of Child Neurology, University of Rochester, Rochester, New York;

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Ifunanya Dallah Department of Neurology, University of Rochester, Rochester, New York;

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Manoj Mathews University Teaching Hospitals–Children’s Hospital, Lusaka, Zambia;

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Musaku Mwenechanya University Teaching Hospitals–Children’s Hospital, Lusaka, Zambia;

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Omar K. Siddiqi Department of Internal Medicine, University Teaching Hospitals–Adult Hospital, Lusaka, Zambia;
Department of Neurology, Harvard Beth Israel Deaconess Medical Center, Boston, Massachusetts;

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Izukanji Sikazwe Centre for Infectious Disease Research Zambia, Lusaka, Zambia

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Gretchen L. Birbeck Department of Neurology, University of Rochester, Rochester, New York;
University Teaching Hospitals–Children’s Hospital, Lusaka, Zambia;

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DOI:
https://doi.org/10.4269/ajtmh.21-0091
Volume/Issue:
Volume 105: Issue 5
Page(s):
1429–1433
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ABSTRACT.

In much of sub-Saharan Africa, lumbar punctures (LPs) are performed less frequently than indicated. This is often attributed to patient/family refusal; however, other factors have not been systematically evaluated. We investigated predictors of LP performance for a prospective cohort of people with HIV and new-onset seizures at three hospitals in Zambia. We enrolled 257 participants, including 184 (72%) adults and 144 (56%) urban participants. LPs were performed for 65% of adults and 33% of children, and for 69% of urban and 38% of rural participants. In multivariate logistic regression analyses, LP completion was significantly less likely at one rural site and among children compared to adults. The worst WHO HIV disease stage was associated with increased odds of undergoing LP. Low LP completion rates in Zambia are multifactorial and related to health system and provider factors and patient/family preferences. Further research is necessary to understand this complex problem and develop interventions to improve LP uptake.

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Author Notes

Address correspondence to Gretchen L. Birbeck, Department of Neurology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642. E-mail: gretchen_birbeck@urmc.rochester.edu

Financial support: Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (award numbers R01NS094037 and R01NS094037-S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institute of Health.

Authors’ addresses: Deanna Saylor, Johns Hopkins University School of Medicine, Baltimore, MD, and University Teaching Hospital, Lusaka, Zambia, E-mail: deanna@jhmi.edu. Melissa Elafros, University of Michigan School of Medicine, Ann Arbor, MI, E-mail: elafrome@med.umich.edu. David Bearden, Ifunanya Dallah, and Gretchen L. Birbeck, University of Rochester Medical Center, Rochester, NY, E-mails: david_bearden@urmc.rochester.edu, ifunanya.dallah@chet.rochester.edu, and gretchen_birbeck@urmc.rochester.edu. Manoj Mathews and Musaku Mwenechanya, University Teaching Hospital–Children’s Hospital, Lusaka, Zambia, E-mails: m_s_mathew@yahoo.com and mmusaku@gmail.com. Omar K. Siddiqi, Beth Israel Deaconess Medical Center, Boston, MA, and University Teaching Hospital, Lusaka, Zambia, E-mail: osiddiqi@bidmc.harvard.edu. Izukanji Sikazwe, Centre for Infectious Disease Research Zambia, Lusaka, Zambia, E-mail: izukanji.sikazwe@cidrz.org.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2021
Received:
23 Jan 2021
|
Accepted:
19 May 2021
|
Published Online:
09 Aug 2021
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Greenlee JE, 1990. Approach to diagnosis of meningitis. Cerebrospinal fluid evaluation. Infect Dis Clin North Am 4: 583–598.

  • 2.

    Scheld WM, Whitley RJ, Marra CM, 2014. Infections of the Central Nervous System. 4th ed. Philadelphia, PA: Wolters Kluwer Health.

  • 3.

    Siddiqi OK et al., 2017. New-onset seizure in HIV-infected adult Zambians: a search for causes and consequences. Neurology 88: 477–482.

  • 4.

    World Health Organization, World Federation of Neurology , 2017. ATLAS: Country Resources for Neurological Disorders. 2nd ed. Geneva, Switzerland: WHO.

  • 5.

    Parry E, Godfrey R, Mabey D, Gill G, 2004. Principles of Medicine in Africa. 3rd ed. Cambridge, UK: Cambridge University Press.

  • 6.

    Herbert G, Ndiritu M, Idro R, Makani JB, Kitundu J, 2006. Analysis of the indications for routine lumbar puncture and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in East Africa. Tanzan Health Res Bull 8: 7–10.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Thakur KT et al., 2015. Lumbar puncture refusal in sub-Saharan Africa: a call for further understanding and intervention. Neurology 84: 1988–1990.

  • 8.

    Global Burden of Disease Meningitis Collaborators , 2018. Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 17: 1061–1082.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hampande ML, 2009. Attitude and Determinant of Lumbar Puncture Acceptability Among Caregivers at Three Hospitals in Zambia. Lusaka, Zambia: University of Zambia School of Medicine. Available at: http://dspace.unza.zm/handle/123456789/551.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    King MB, Rwegerera GM, 2015. An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience. Afr J Emerg Med 5: 66–69.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Deng CT, Zulkifli HI, Azizi BH, 1994. Parents’ views of lumbar puncture in children with febrile seizures. Med J Malaysia 49: 263–268.

  • 12.

    Khakshour A, Hashemi M, Tavakoli H, Sheikhi Z, Kiani MA, Elmi S, 2013. Evaluation of parental attitudes toward lumbar puncture in their children. Int J Pediatr 1: 19–23.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Alnajim SA et al., 2017. Common misconceptions of lumbar puncture complications among parents in the eastern region of the kingdom of Saudi Arabia. Int J Adv Res (Indore) 5: 1257–1264.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Narchi H, Ghatasheh G, Al Hassani N, Al Reyami L, Khan Q, 2012. Why do some parents refuse consent for lumbar puncture on their child? A qualitative study. Hosp Pediatr 2: 93–98.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Narchi H, Ghatasheh G, Hassani NA, Reyami LA, Khan Q, 2013. Comparison of underlying factors behind parental refusal or consent for lumbar puncture. World J Pediatr 9: 336–341.

    • PubMed
    • Search Google Scholar
    • Export Citation

Expert Committee on Hepatitis

First Report. World Health Organization Technical Report Series No. 62 (Available also in French). 26 pp. Geneva, W.H.O., Palais des Nations. March, 1953. Price 1/6, $0.20, Fr. fr. 65.-; Sw. fr. 0.80

Parasitic Infections of Man

by Harry Most, M.D., Editor. Symposium No. 4 of the Section on Microbiology, New York Academy of Medicine. 220 pp., cloth. New York, Columbia University Press, 1951. $4.50

Author:
G. F. Otto

Immunology

by Noble Pierce Sherwood. Ph.D., M.D., Professor of Bacteriology, University of Kansas—3rd Edition, 731 pp., illustrated, cloth. St. Louis: The C. V. Mosby Co., 1951. $8.00

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